Tag: Reimbursement

Revenue CYcle Success

3 Issues Revenue Cycle Leaders Will Have To Battle In 2020

First hand experiences from the country’s most innovative revenue cycles will be shared next month in West Palm Beach, Florida. What issues keep revenue cycle executives up at night? As the HealthLeaders’ revenue cycle editor, I will moderate discussions and hear firsthand experiences of successes, challenges, and the latest ideas coming out of the country’s most innovative […]
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OPPS Rule

2020 Outpatient Proposals: 5 Rules You Should Know From CMS

Hospital and health system executives should monitor these proposals for provisions that will affect their organizations’ operations. The 2020 annual rule cycle has been active for CMS. Several proposals in the outpatient prospective payment system (OPPS) proposed rule is controversial, although there is at least one provider-friendly change. Here’s a roundup of five regulatory rules […]
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Denial Management Services

Developing A Hospital Claim Validation Strategy To Prevent Denials

A comprehensive hospital claim validation strategy that prevents denials and improves efficiencies hinges on the right blend of retrospective and pre-bill reviews. The time to strengthen hospital compliance programs through claim validation is now. According to healthcare finance and information management leaders surveyed by HIMSS Media, clinical documentation and coding were the revenue cycle processes most vulnerable […]
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Hospice Claims

Prevent Billing Errors to Reduce Hospice Claim Denials

Effective revenue cycle management can reduce hospice claim denials, particularly those associated with billing or documentation errors. In addition to slowing down payments or losing revenue, submitting inadequate or incomplete required written documentation is a sure-fire way to bring surveyors or auditors to a hospice’s doorstep. As regulators increasingly fix their eyes on the hospice space, providers […]
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Protective Appeals

CMS Fights Growing Number of Appeals

Providers are encouraged to file protective appeals. “In section XI of the preamble of the proposed rule, we discussed the growing number of Provider Reimbursement Review Board (PRRB) appeals made by providers and the action initiatives that are being implemented with the goal to decrease the number of appeals submitted; decrease the number of appeals […]
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E/M Coding Guidelines

4 Strategies For Accurate Medical Coding & Denial Prevention

4 Strategies For Accurate Medical Coding and Denial Prevention Payers typically deny evaluation and management codes (E/M code) on the back end of the billing process, which can cause costly reimbursement recoupments, according to Medical Economics. Four tips to avoid denials caused by inaccurate E/M levels: Make sure the E/M code supports the specific patient encounter. […]
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MIPS

Unpacking Proposed Merit-Based Incentive Payment System Changes

CMS recently proposed Merit-Based Incentive Payment System changes in 2020 and beyond, including a new participation framework and higher performance thresholds. CMS is planning to overhaul reporting for the Merit-Based Incentive Payment System (MIPS) in order to make the pay-for-performance program less burdensome and more meaningful to providers, according a recently proposed rule. As reported last week, […]
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MIPS-Payment Models

CMS Unveils New MIPS ‘Framework’ Aimed at Reducing Reporting Burden

The Trump administration has proposed updates to the Merit-based Incentive Payment System (MIPS) it says would ease the quality reporting burdens in the program. The Centers for Medicare & Medicaid Services (CMS) introduced a new framework for MIPS called MIPS Value Pathways (MVPs) with the goal of making it easier for physicians to participate in the program. Under […]
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Denial Management Services

Medical Necessity and Denial Management

Quality work reduces the burden of the denial management process. When my children were young, they really enjoyed the movie “The Neverending Story.” It’s about a boy who reads a magical book that tells a story of a young warrior whose task is to stop a dark force called “The Nothing” from engulfing a mystical […]
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